iraj aghaei

Substance use disorders (SUDs) pose substantial challenges to society, creating widespread negative effects. Given their frequent and direct contact with patients, nurses hold a vital position in managing and addressing these disorders. This systematic review aimed to examine nurses’ understanding of substance use and their perceptions of individuals affected by these conditions.

This systematic review involved a comprehensive search of online databases such as PubMed, Web of Science, and Scopus, utilizing relevant keywords up to July 9, 2021. Only studies published in English and aligned with the review’s objectives were considered. The quality of the included studies was evaluated using the AXIS tool.

A total of 3273 nurses participated across 12 studies. The results indicated that nurses’ knowledge about substance use was moderate, and their attitudes toward substance users were generally positive. Knowledge-related factors included variables such as age, gender, and work experience. Similarly, age, gender, ethnicity, education level, job position, work experience, participation in workshops on substance use, interest in patient care, hours spent on substance use courses during education, and continuing education hours related to substance use were identified as potential factors influencing attitudes.

Therefore, holding workshops and improving guidelines for patient care with SUDs can enhance nurses’ knowledge and attitudes and, ultimately, the quality of nursing care.

Due to the crucial role of polyamines during fetal growth and development, we aimed to determine the effect of prenatal administration of agmatine, an endogenous active metabolite of arginine, and a nutritional supplement, on autistic-like behaviors, oxidative-anti-oxidative profile, and histopathological changes of the prefrontal cortex (PFC) and CA1 area of the hippocampus in valproic acid (VPA) model of autism in male rats.  VPA was injected intraperitoneally on embryonic days (ED) 12.5, and the pregnant rats were gavaged with agmatine between E6.5 to E18.5 (13 days), at doses of 0.001, 0.01, and 0.1 mg/kg. The autism-like behaviors and memory of male pups were analyzed via open-field, three-chamber, and novel object recognition tests. Serum oxidative stress and the histological changes in the PFC and CA1 were assessed at the end of the study.  The results suggest that prenatal agmatine reduced autistic-like behaviors by decreasing cell loss in CA1 and PFC. We observed no alterations in superoxide dismutase (SOD) level and total anti-oxidant capacity (TAC) between groups. VPA decreased catalase (CAT) activities, while agmatine decreased malondialdehyde (MDA) activity.  Overall, this investigation suggests that agmatine may be a potential candidate for the early treatment and even prevention of appearance of autism symptoms.

Trauma is one of the important causes of disability, death and major health problem in the world. Various instruments are used to assess the clinical outcomes of trauma patients. The aim of this study was to compare the Revised Trauma Score (RTS) with the MGAP score in determining the clinical outcomes. A retrospective cross-sectional analytical study was conducted on 1000 multiple trauma patients admitted to Poursina Hospital in Rasht. The data collection instruments included a three-part checklist of demographic and clinical characteristics, RTS and MGAP scores, and clinical outcomes (length of hospitalization and mortality). Data were analyzed using descriptive and non-parametric statistical tests by SPSS 21 software. To determine the predictive power of RTS and MGAP mortality using the ROC test, in addition to obtaining the area under the curve (AUC), the cut-off point, sensitivity, specificity, positive and negative predictive values (PPV and NPV) were obtained. The findings showed that 3% of patients (CI: 95%) died and the length of hospitalization was 3.7±2 days. The mortality prediction level of RTS and MGAP instruments for trauma patients was significant (P<0.001) according to AUCs of 97.9% and 98.3%, respectively. Correlation between MGAP and RTS for the length of hospitalization were significant (r=-0.267and r=-0.274, p<0.001), but the intensity of correlation between MGAP and RTS was not significant. The best cut-off points for RTS and MGAP were equal to 7 and 22.5, respectively, with sensitivity rates of 98.1% and 92.3%., specificity rates of 96.7%, and 92.3%., PPV values of 97.7% and 92.3% and NPV values of 92.3% and 98.1%, respectively. MAGP and RTS instruments can predict the clinical outcomes of trauma patients well, but they did not have a significant superiority over each other. Therefore, the preferred choice of one of these agents requires multicenter studies.

Epilepsy is one of the most common neurological disorders. Though there are several effective drugs for treating epilepsy, most drugs are associated with side effects and drug interactions. Stachys lavandulifolia used in Iranian traditional medicine has proven anti-anxiety and sedative properties. The current study aimed to evaluate the anticonvulsant effect of hydroalcoholic extract of S. lavandulifoliaon the Pentylenetetrazole (PTZ)-induced seizure in male mice and the role of benzodiazepine and opioid receptors. 

This study was conducted on 100 male mice, randomly categorized into 10 groups: Normal Saline (NS), two diazepam groups (0.025 and 0.1 mg/kg), three S. lavandulifolia extract groups (50, 100, and 200 mg/kg), diazepam 0.025 mg/kg+S. lavandulifolia extract 50 mg/kg, and three groups that pretreated with NS, flumazenil, or naloxone, 5 min before injection of 200 mg/kg S. lavandulifolia extract. After 30 min, PTZ (80 mg/kg) was injected into animals, and seizure indices were evaluated. 

The S. lavandulifoliaextract attenuated the PTZ-induced seizures in a dose-dependent manner, and pretreatment with flumazenil reversed this effect. However, pretreatment with naloxone could not reverse this effect because seizure indices in the naloxone pretreated group were lower than that in the normal saline group. The combination of an ineffective dose of diazepam and S. lavandulifoliaextract decreased PTZ-induced seizures. 

The results of our study showed the anticonvulsant properties of hydroalcoholic extract of S. lavandulifolia. These effects might be due to the impact of the components of this extract on the central benzodiazepine system.

Acute Kidney Injury (AKI) is a frequent complication of kidney failure with high mortality, leading to brain dysfunction. This study aimed to investigate the possible protective effect of Ischemic Postconditioning (IPo) against brain dysfunction induced by Bilateral Renal Ischemia (BRI).

Male Wistar rats underwent BRI, sham, or IPo surgery 24h and 1w after reperfusion. The rats’ explorative behaviors and motor function were evaluated by an open field, rotarod, and wire grip tests. The cognitive function was assessed by passive avoidance learning and Morris water maze tests. Western blotting was performed to evaluate hippocampal Brain-Derived Neurotrophic Factor (BDNF) expression.

The impairment of balance function induced by BRI was not reversed; however, passive avoidance learning impairment was reversed by postconditioning 24h after reperfusion. IPo increased muscle strength compared to the BRI group; however, explorative behaviors and balance function had no difference 1w after reperfusion. BRI significantly decreased the BDNF protein expression in the hippocampus, and postconditioning increased 24h after reperfusion.

The obtained results demonstrated the deleterious effect of BRI on cognitive and balance function 24h after reperfusion. IPo indicated a curative effect against cognitive dysfunction probably by enhancing BDNF protein expression in the hippocampus.

Acute Coronary Syndrome (ACS) is one of the most common causes of death in patients with Cardiovascular Diseases (CVD). In addition to the known physical factors influencing the incidence of CVD, some psychologists have pointed to the role of psychological factors such as personality type.

This study aimed to determine the role of type D personality in ACS patients in Iran in 2019.

In a case-control study, 112 participants were included. A total of 56 patients with ACS were compared with 56 matched people without ACS. They were selected by the convenience sampling method. Type D scale 14 (DS14) was used to assess the type D personality. The Chi-squared test, independent t-test, and multivariate logistic regression were used to analyze the obtained data.

The Mean±SD age in the case group was 57.23±8.562 years, and in the Mean±SD age in the control group was 57.25±8.529 years. Also, most participants in both groups were men (71.4%). The result showed that type D personality was more prevalent in patients with ACS (26% vs 7.1%; P=0.006). Based on multivariate regression analysis and after controlling for demographic and clinical risk factors, type D personality was independently associated with ACS (OR=5.323, 95% CI; 0.987-28/712, P=0.052). Also, after investigating subscales, only social inhibition had a significant association with ACS (P=0.008).

Type D personality is an independent risk factor of the ACS. Thus, type D personality may make people vulnerable to the ACS. Therefore, besides medical interventions, clinicians must consider behavioral interventions to reduce the incidence of ACS.

Stress could play either helpful or harmful roles in vestibular compensation, the process of recovery after vestibular system lesions. Herein, we examined the effect of two stressor types on vestibular compensation: chronic anxiety disorder induced by early maternal separation (MS), and caloric restriction by an intermittent fasting (IF) diet.

Male Wistar rats (n=56) received maternal separation (the MS group), intermittent fasting (IF group), unilateral vestibular deafferentation (UVD group), or a mixture of these interventions (UVD+IF, UVD+MS, and UVD+IF+MS). All the groups were compared with control animals. The animals’ balance, motor coordination, anxiety, locomotor activity, and serum cortisol levels were evaluated by rotarod, open field, and enzyme-linked immunosorbent assay methods, respectively. The data were compared with those of the healthy control (HC) group.

The UVD animals did not show a significant change in the time on the rod, except for the IF+UVD group (p=0.04). There was no significant difference between the experimental groups on the open field indices, except for the MS+IF+UVD group which traveled a significantly less total distance (p=0.02). Serum cortisol levels were significantly higher than HCs for all the groups except for the sham saline and IF+UVD group (p<0.05).

IF seems to promote compensation after UVD, while MS may disrupt it. However, IF loses its beneficial outcomes if the animal has received another source of stress, i.e. MS.

Airway management is a fundamental principle in treatment of emergency patients and reduction of mortality. The purpose of this study was to determine the performance of prehospital emergency medicine servises (EMS) in endotracheal intubation and its related factors in mannequin.

This cross-sectional analytic study was performed in 70 EMS  staff in Rasht, Iran 2019. The participants were selected through census sampling. Demographic and occupational characteristics questionnaire and a checklist for tracheal intubation performance were used. Data were analyzed in SPSS V21, using Mann-Whitney U Test, Kruskal–Wallis Test, and ordinal logistic regression.

The overall performance of EMS staff in placing endotracheal tube was moderate. There were significant correlations between endotracheal intubation and work experience (P=0.051), and experience and numbers of tracheal intubation in human (P=0.051, P=0.022, and P=0.021, respectively).

According to this study, frequent in-service training courses are needed to improve the performance of EMS staff.

Delirium is a recurrent cognitive disorder which is one of the most common neurologic diagnosis in patients who have had pelvic surgeries. This complication occurs in a short time and early diagnosis results in early management. Current study was done to investigate the frequency of delirium and identifying the factors affecting its incidence in patients with pelvic surgeries. This analytical study was performed in patients >60 years of age admitted in orthopedic wards in Rasht hospitals, Iran, due to pelvic surgery. The samples (n=252) were selected using convenience sampling. Data were collected using a demographic questionnaire and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. All patients were examined before the surgery, at 6, 24, 48, and 72 hours after the surgery and also before discharge in which their cognitive status and average cognitive scores were recorded. We investigated 252 patients (mean age: 72.90±7.33) including 67 (26.6%) males and 185 (73.4%) females of whom 69% were married. Overall incidence of delirium was 18.3%. Significant association was found between the incidence of delirium and history of smoking, psychiatric medications (P< 0.001), and the type of anesthesia (P< 0.05). This study showed high prevalence of delirium in patients who have had pelvic surgery. Therefore, more focus on the factors affecting the incidence of delirium before the surgery and evaluation of patients early after the surgery could be beneficial in reducing the rate of delirium.

Stress alters sensory and cognitive function in humans and animals. Angiotensin (AT) receptors have demonstrated well-established interactions in sets of physiological phenomena. AT1 receptors can play a part in stress-induced activation of hypothalamic-pituitary-adrenal (HPA) axis; besides angiotensinergic neurotransmission plays a pivotal role in stress-evoked physiological responses. AT1 receptors are also involved in nociception and memory. The objective of the current study was to evaluate the effects of losartan as an AT1R antagonist in locomotor activity, nociception and memory impairments induced by sub-chronic swim stress.
A two-session forced swimming stress protocol was administered to the rats. Pretreatment with losartan (10 mg/kg, IP) or saline was made before each swimming session. Locomotor activity, anxiety-like behavior, nociception, and passive avoidance learning were evaluated 24 hr after last swim stress session.
Swim stress induced increased anxiety-like behavior in the open field test, which pretreatment with losartan did counterbalance. Increased thermal threshold was observed in the nociceptive measurement after swim stress. Pretreatment with losartan attenuated the increased threshold and also inhibited a decreased step-through latency that was observed in the memory paradigm after swim stress.
The results of this study indicate that sub-chronic swim stress impairs passive avoidance learning, anxiety-like behaviors, and nociception; and AT1 receptor seems to have a modulatory role in these alterations. However, further studies are suggested to examine the protective effect of AT1R inhibitors on stress-induced impairments in sensory and cognitive function.

One of the most common causes of mortality in acute kidney injury is brain dysfunction. Here we investigated the possible protective effect of erythropoietin (EPO) on cognitive impairments induced by bilateral renal ischemia (BRI).
Eighty male Wistar rats were allocated into 8 groups: 1, 2) Sham (Vehicle), 3, 4) Shamჳ, 5, 6) BRI, 7, 8) BRIჳ. The groups followed by the reperfusion periods of 24hours (24h) and 1week (1w). EPO or saline was administrated 30 min before surgery (1000 IU/kg, i.p.). The cognitive function was assessed by passive avoidance learning and Morris water maze tests. Hippocampal brain-derived neurotrophic factor (BDNF) protein expression was assessed by western blotting.
BUN (blood urea nitrogen) and creatinine (Cr) concentrations were significantly increased in BRI group 24h after reperfusion. BRI rats had just an increased level of BUN but not Cr 1w after reperfusion. EPO reversed passive avoidance learning impairments observed in BRI group 24h after reperfusion. There were no significant differences in spatial and passive avoidance learning between experimental groups 1w after reperfusion and histological evaluation confirmed the behavioral data. BRI decreased significantly the BDNF protein expression in the hippocampus and EPO increased that 24h after operation.
These observations showed protective effect of EPO against cognitive dysfunctions following BRI 24h after reperfusion through increase in BDNF protein expression.

Background and Trauma scoring systems help physicians and nurses in recognizing the severity of trauma and its management. The purpose of this study was to investigate and compare the predictive ability of mortality rates of two trauma scoring systems (MGAP and GAP) in multiple trauma patients.
In this cross-sectional study, we used the data available in electronic records for trauma patients admitted to Rasht Poorsina Hospital, Iran. Demographic data, and GAP and MGAP (Mechanism, Glasgow Coma Scale, Age, and Pressure) scores for 1541 patients were extracted. Then, the ability of both scores in short-term (24 hours) and long-term (4-week) mortality prediction rates was analyzed using SPSS V21.
The surface areas under the curve ratio of ROC for predicting short-term mortality rates were 0.947 and 0.938, and for long-term mortality rates were 0.928 and 0.914 for GAP and MGAP, respectively (P Both GAP and MGAP could appropriately predict mortality rate without any significant difference. Therefore, these scores could be used as triage tools, and in predicting the severity of injuries and mortality.

Preclinical studies show that iron plays a key role in mediating neuronal injury. This study was performedin order to identify the relationship between the serum level of ferritin and severity of the brain injury which occur after an Intracerebral hemorrhage (ICH). This was a cross sectional descriptive – analytic study, which was conducted on those patients who had suffered from an ICH and had attended Poursina Hospital. The Serum levels of ferritin were measured at admittance. A Cranial CT scan was performed at admission and also 72 hr afterward. Hematoma and edema surrounding the hematoma volumes were also measured at entrance and 72 hr afterward. Data analysis was carried out by a descriptive - analytic statistics approach and calculated later on by the Spss-20 software. In this investigation, 63 patients were studied, from which 34 (54%) were male and 29 (46%) female. The average age of the patients was 69.7± 11.9 (Min 43 and Max 94 years old). A significant relationship was observed between the level of ferritin and the edema volume surrounding the hematoma at first and next 72 hr after the patients were admitted. These results delineated the effective role of iron on the edema volume elevation. More studies are essentially urged to ascertain the clinical evaluation of the curing effect of iron chelators in those patients who suffer from ICH.

Defensive medicine prompts physicians not to admit high-risk patients who need intensive care. This phenomenon not only decreases the quality of healthcare services, but also wastes scarce health resources. Defensive medicine occurs in negative and positive forms. Hence, the present study aimed to determine frequency of positive and negative defensive medicine behaviors and their underlying factors among general practitioners in Southeast Iran. The present cross-sectional study was performed among general practitioners in Southeast Iran. 423 subjects participated in the study on a census basis and a questionnaire was used for data collection. Data analysis was carried out using descriptive and analytical statistics through SPSS 20. The majority of participants were male (58.2%). The mean age of physicians was 40 ± 8.5. The frequency of positive and negative defensive medicine among general practitioners in Southeast Iran was 99.8% and 79.2% respectively. A significant relationship was observed between working experience, being informed of law suits against their colleagues, and committing defensive medicine behavior (P< 0.001). The present study indicated high frequency of defensive medicine behavior in the Southeast Iran. So, it calls policy-makers special attention to improve the status quo.